FGM/C Shifting Sands

Articles on Shifting Sands

Zero Tolerance for FGM: Winning battles but losing wars

Published 7 February 2018 Associated Categories Responses
FGM: Prosecution Rates

Essay. February 6th 2018 was #MeTooFGM day. The social media campaign was launched in Dublin with the backing of the #MeToo movement. The organisers hoped that a thunderclap, starting in Dublin, would reverberate across Africa, the US, Asia and Australia and reach a million users by midnight.

The campaign is a development on the 15 year old International Day of Zero Tolerance for FGM. Sponsored by the United Nations, it aims to raise awareness of, and to eliminate the practice by 2030. This ambition has been adopted enthusiastically by politicians, agencies, activists and NGO’s keen to implement programmes and initiatives within targeted countries and communities. Governments are held to account through monitoring sustainable development goals, SDG 5.3 in this instance, where the aim is the elimination of all harmful practices, like FGM.

The UNFPA and UNICEF report they jointly lead the largest global programme towards abandonment of FGM and work closely with governments, grass-roots community organisations and other stakeholders, backed by the latest social science research.

But beneath the umbrella term ‘FGM’ lie a variety of genital cutting practices, styles and degrees that are glossed over 

Infibulation (WHO type III) is the most severe and likely to cause problems. Despite that it is estimated to constitute less than 10% of all genital cuttings, it is popularly assumed the commonest. Practiced mainly in the Horn of Africa, the incidence is voluntarily decreasing, particularly among urbanites.

The other 90% constitute all other practices. Type I covers procedures involving reduction of either the clitoral hood or the external or protruding bits of clitoral tissue, or both. Type II involves partial or complete labial reductions and partial or complete reduction of the external clitoral tissue. Type IV covers everything not included above.

UNICEF suggests that at least 200 million girls and women alive today, living in 30 countries, have undergone some form of the practice. And an estimated three million African girls are at risk of undergoing it, every year.

In Africa, 28 countries are known to practice FGM, and it’s where most preventive work has been directed. At least 23 countries have laws in place that expressly prohibit FGM. Liberia can also be added now. And activists hope that Somaliland will follow soon.

A variety and combination of legal, political, health and community approaches led the UNFPA to enthusiastically report, in May 2012, (the) ‘Tide is Turning Against Female Genital Mutilation/Cutting’, Later that year, in December, the UN General Assembly adopted a resolution on the elimination of the practice. And the UN reported in 2017 that the practice had declined by 24 per cent since 2000.

On the ground, networks of religious leaders, parliamentarians, non-governmental organisations, youth and human rights activist support and help implement campaigns. It’s not unusual for activists to have a huge emotional investment in ending the practice.

Britain’s Department for International Development (DfID) boasts a flagship programme ‘Towards Ending FGM/Cutting in Africa and Beyond’. In 2013, it made the single largest ever donor commitment to tackling FGM globally by launching a £35 million 5-year programme across 16 countries. It also supports the UN Joint Programme on FGM (£21m, 2013-18). The Girl Generation has been allocated (£6m, 2014-19), and the Population Council (£8m, 2015-2020). That’s at least£70M that British people are contributing towards anti-FGM initiatives.

Unsurprisingly therefore, bearing in mind the players involved and the money invested, positive progress is regularly reported. Over the last 30 years, the incidence of FGM/C is estimated to have decreased by 50% in Africa. Headlines like ‘Six African countries that have made significant progress in the fight against FGM’ are common.

But objective evidence demonstrating that FGM/C is declining (or growing) is difficult to come by. And behind the positive headlines a different picture is beginning to emerge.

While some are voluntarily abandoning particular types or all genital cutting of children, many resent being told they must, and pay lip-service to the unforgiving, zero-tolerance approach.  They see a valued, traditional, social, environmental, cultural and religious practice, derogatorily named ‘mutilation’ by the UN in 1994 to problematise it in the public imagination, constantly being highlighted and under attack.

So some continue the practice underground, on ever younger children. But others are beginning to openly challenge and defy the programmes, and the practice is resurfacing.

Recent examples from Africa suggest that this prohibitionist approach is unwelcome.

Kenya formally banned FGM in 2011 but not everybody has toed the line there. Two weeks before the ‘16 Days of Activism Against Gender-Based Violence’ held in Nov/Dec 2017, around 2,000 Pokot girls underwent FGM/C.

Similar happened in Kuria, which has one of the highest FGM/C rates in Kenya in December 2016. Then, more than 100 girls underwent the practice in a week. This was despite that several high-level government officials dealing with FGM/C had visited a few times that year, including from the national anti-FGM Board.  And ‘Many village chiefs agreed to cooperate fully to ensure that no girl was cut.’

The BBC too reported recently that Samburu girls continue to be cut. Kenyan Academic, Naisula Lapario, said that FGM/C had been driven underground and that the girls are being cut in even more dangerous conditions, at night. She thinks people might be willing to consider alternatives, but because of the Zero Tolerance approach, options cannot even be discussed with them.

In a surprising move, in January ’18, Dr Tatu Kamau asked the Kenyan courts to overturn the anti-FGM ban. She believes it infringes the rights of adult women capable of giving consent from participating in a cultural practice: “If women can decide to drink, to smoke, women can join the army, women can do all sorts of things that might bring them harm or injury … a woman can [also] make that decision. And once she has made that decision, she should be able to access the best medical care to have it done.” She also argues that it’s discriminatory to allow boys, but not girls, to be circumcised.

Activists are (predictably) outraged, but professionals and elders support her case. They also want the anti-FGM board disbanded because it has caused unnecessary suffering in the fight against the female cut.

In the Gambia, 56% of female children have traditionally undergone FGM/C by 14 years. But in 2015, former president, Jammeh, announced that FGM was being banned with immediate effect. This was after a documentary ‘Jaha’s Promise’ focussing on the work of the anti-FGM activist, Jaha Dukureh, shone a spotlight on the practice there. She has since been credited with influencing the President to instigate the ban. And has recently been appointed first UN Regional Goodwill Ambassador for Africa.

But the ban wasn’t popular, although people tended to obey it out of fear. Soon after the President fled into exile in Jan ’17, genital cutting resumed. One mother said “If Gambia is a democracy now, why should anyone stop us from practicing our religion and tradition?” And an activist reported “If you go into communities, they tell you that the law went with the former president.”

A distraught representative of the Girls’ Agenda there summed up her disappointment at this development, saying ‘It’s a practice that you have laid down your life for, and at some point you think it’s almost coming to an end but now you are drawn back, steps back to where you have been before”.

Meanwhile, in Uganda, where the practice of circumcising young girls has been in decline since it was banned in 2009, outlawing that tradition has wrought a high social cost for some uncircumcised women. Shunned and mistreated by society and ostracised by their husbands, some are now having to undergo circumcision as adults.

African leaders generally tread warily when it comes to bowing to outside pressure to end FGM/C. In Nigeria, just before the former president left office in May 2015, he imposed a nationwide ban. While this was popularly interpreted as a way of influencing his political legacy, others considered it an act of cowardice by a politician fearful, whilst in office, of the electorate’s wrath.

The former president of Liberia did similar. On her last day in office in Jan ‘18, Sirleaf-Johnson signed a year’s ban, making it an offence to perform FGM/C on anyone under 18. Although welcomed by some, others, knowing how much the practice is valued by politically influential women’s societies there, consider it political opportunism and cowardice.

Sierra Leone has almost uniquely resisted international calls to ban FGM/C. But the impending elections have prompted an anxious British MP to question a colleague about the steps being taken in response to reports that FGM has been used by political parties there as part of the electoral process. She was advised: ‘We are not aware of any formal reports of FGM being used as part of the electoral process; but with our partners we are closely monitoring all risks around the election.’

Britain’s DfID remains committed to working with the next Sierra Leonean Government and others to help tackle FGM. Its flagship programme ‘Towards Ending FGM/Cutting in Africa and Beyond’ has committed approximately £70M towards initiatives.

But in brazen defiance of the international 2018 Zero Tolerance Day events, Sierra Leone’s first Female Circumcision Awareness Week is being held between 5-10 February, 2018. It’s being promoted as ‘an opportunity for open, public dialogue about an area of women’s private lives that has received its share of unwanted global media attention.’ A protest about the WHO’s use of the demeaning label ‘mutilation’ was held in Freetown.

Somaliland’s famous midwife, Edna Adan, says that despite a reduction in the numbers of young girls being cut there, and in the wider Somali nation, things are ‘slipping back’. “Unless we get people sitting on the mat in the villages, taking time to speak to the grandparents and the parents and the religious leaders, we lose what ground we have made.” Nevertheless, activists are pressuring politicians to ban the practice there.

Abigail Urunga recently summarised why the practice is so important to some Africans: ‘Africa still, unfortunately, has a long way to go regarding FGM. It’s an internationally problematic NGO agenda, for a number of reasons – they don’t have any idea how to stop it, what they’re coming up against, and even a basic understanding of what this whole process means to our culture – the idea that it is a rite of passage enmeshed in centuries of tradition, a tradition that, unfortunately, we refuse to let go of.’

It isn’t that campaigners haven’t been warned. Back in 1997, calls to action by Western feminists and human rights activists provoked negative reactions. ‘African women have perceived many of these efforts as condescending and derogatory toward their culture. In the words of one infibulated Somali woman, “If Somali women change, it will be a change done by us, among us. When they order us to stop, tell us what we must do, it is offensive to the black person or the Muslim person who believes in circumcision. To advise is good, but not to order.”

Beyond Africa, a ritual nick to the clitoral hood called ‘khatna’ or ‘khafz’, has attracted most attention recently.

It is observed for religious reasons, predominantly by Dawoodi Bohra’s, a Shia Muslim sect. Three quarters of India’s Dawoodi Bohra women are reported to have undergone it. It is also practiced by Muslims in Indonesia, Sri Lanka and by Sunni Muslims in Kerala.

Unicef reported in 2016 that 49 per cent of girls (0-11) in Indonesia are cut. The Indonesian government’s definition of female circumcision then was “an act of scratching the skin that covers the front of clitoris without injuring the clitoris.” More than half of the procedures are medicalised: performed by midwives or other health professionals.

In Sri Lanka, activists want the ritual banned. But members of its Moor and Malay Muslim community – nearly two million and 60,000 respectively – are resisting, saying it is misleading and damaging to them to brand “a nick on the hood or prepuce of the clitoris”, FGM. They deny that the practice is mutilation.

Activists want it banned in India but are meeting resistance there also. They advocate for the rights of Dawoodi Bohra women to live with dignity and honour, able to exercise their religious and cultural rights, including to practise ‘khafz’.

A recent court case in Australia and another to be held in the US illustrate that any form of genital cutting in girls is considered mutilation and therefore illegal

In November 2015, in Australia, the mother of two girls and a retired midwife were found guilty of cutting them under its anti-FGM law. A Bohra religious leader was convicted of being an accessory after the fact. The three were sentenced to 15-month prison terms.

They were found guilty despite lack of evidence of ‘mutilation’. A paediatric gynaecologist told the court then: “If you were going to remove tissue, it would hurt and bleed”. And “The information I was given was that the girls did not complain of pain or problems in the days after. So it means whatever was done was a minor procedure.”

She agreed it was possible that the girls clitorises had been pricked or pierced but had healed without sign of injury. When asked if it was possible the clitoris of either girl had been cut, the doctor replied that any cut would have been “very superficial”. No harm had been caused to the children, but because the procedure fell under the umbrella term ‘FGM’, a guilty verdict was pronounced.

Another trial is scheduled to be held in the US in June 2018. A Dawoodi Bohra medical doctor is being charged with illegally carrying out ‘khafz’ on young girls in Detroit. And accomplices will be charged with aiding and abetting this federal crime.

The doctor’s attorney has already successfully argued that the most serious charge – conspiracy to transport minors with the intent to engage in criminal sexual activity, be dropped on the grounds that the ancient, non-invasive ritual did not qualify as “criminal sexual activity”.

The defence is expected to argue the procedure did not involve cutting and was religious in nature. Dawoodi Bohra’s say there is no clinical evidence to prove that ‘khafz’ is harmful, and that the WHO and the US law are wrongly labelling it as ‘FGM’. They consider it a cultural and religious practice and want the authorities to respect their religious freedom to perform it – much in the way that male circumcision is expected and accepted in Muslim and Jewish religions. And male circumcision is legal.


Many agree that criminalisation is not the best way of stopping ‘FGM’ and would prefer community-led educational information and more opportunities for dialogue within practising communities.

This is challenging work, but if people’s hearts and minds are to be engaged, and persuaded to abandon or modify the practice voluntarily, intolerant and interventionists’ tactics must be rethought. They might well heed Edna Adan’s warning to aid agencies, that they should speak directly to practising communities or risk ‘winning battles but losing the war’. Lets hope they all take note.

But what women voluntarily chose to do with their bodies should be their business.



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About the Author -

Bríd is a retired health professional. She started her career as a nurse and midwife in Africa where she worked for almost four years. She encountered FGM/C in Ethiopia. She then moved to London where she worked in the National Health Service as a midwife, community nurse, health visitor, reproductive and sexual health nurse and manager over a period of 30 years. She did not encounter FGM/C during that time despite working with immigrant communities who are reported to practice it still. She is puzzled by the current reported prevalence of the practice, the official response and associated activism. And is worried that they might cause more harm than good.


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